Provider Demographics
NPI:1376939959
Name:GEORGE, ROGER D (EMT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 REX RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3967
Mailing Address - Country:US
Mailing Address - Phone:478-737-8035
Mailing Address - Fax:
Practice Address - Street 1:2064 REX RD STE 4
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:GA
Practice Address - Zip Code:30260-3967
Practice Address - Country:US
Practice Address - Phone:478-737-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-29341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance